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1.
Medicine (Baltimore) ; 98(50): e18379, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852151

RESUMO

RATIONALE: Opacification of monofocal intraocular lenses (IOLs) of various designs and materials has been reported. Hydrophilic acrylic IOLs are more prone to opacification than hydrophobic IOLs, but IOL surface modification by hydrophobic materials may improve biocompatibility, and few opacifications of such monofocal lenses have been reported to date. However, here we describe the characteristics of opacification of hydrophilic refractive multifocal IOLs with a hydrophobic surface modification in a cluster of patients who underwent uneventful cataract surgery. PATIENT CONCERNS: In this retrospective observational case series, the medical records of 7 patients in whom opacification of the IOL was identified after implantation of LS-313 MF30 (Lentis M plus, Oculentis), from November 2017 to May 2019, were reviewed. DIAGNOSIS: All patients had undergone bilateral implantation of LS-313 MF30 IOLs. Ten eyes of 7 patients showed significant opacification at a mean 49.1 ±â€Š10.2 months postoperatively. INTERVENTIONS: The IOLs of 4 cases were explanted. OUTCOMES: All of the opacified cases had received LS-313 MF30 IOLs from February 2014 to August 2014 and experienced decreased visual acuity after 44.6 ±â€Š10.5 months. The explanted IOLs of 4 cases were evaluated by scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), Alizarin-red, and von Kossa staining. These explanted IOLs showed fine and evenly distributed, whitish deposits on the entire IOL, particularly below the surface. Although the constituent of the deposits was identified as calcium by Alizarin-red and von Kossa stain, SEM, and EDX analysis showed no surface deposits of calcium. Paraffin-embedded sections of the IOLs were prepared, and calcium deposition was confirmed by EDX analysis at the subsurface region of the IOL. LESSENS: Significant opacification of these hydrophilic refractive multifocal IOLs with hydrophobic surface modification was found to be due to abnormal calcification of the subsurface of the IOL. Clinicians must be aware of the opacification of this IOL design, despite surface modification. In particular, it should be noted that there is a high likelihood that the patient may experience vision-related symptoms even with moderate opacity and that opacification may lead to a burdensome IOL exchange.


Assuntos
Calcinose/etiologia , Implante de Lente Intraocular/efeitos adversos , Lentes Intraoculares Multifocais/efeitos adversos , Falha de Prótese , Resinas Acrílicas/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos
2.
Chirurgia (Bucur) ; 114(5): 541-549, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31670629

RESUMO

It is estimated that up to 90% of patients with chronic kidney disease develop secondary hyperparathyroidism (sHPT). Although the disease has multiple manifestations, the most important pathological feature, from the point of view of increased mortality, is represented by the ectopic arterial, myocardial and cardiac valvular calcifications. The calcifications are progressive and lead to high blood pressure, left ventricular hypertrophy, atrio-ventricular blocks, angina and myocardial infarction. Therefore the risk of cardio-vascular events is increased. Failure of drug therapy to control disease progression is an indication for parathyroidectomy. In sHPT all parathyroid glands are affected, hence the need to detect 4 glands intraoperatively, by bilateral cervical exploration. However, considering the possibility of ectopic localization of these glands as well as the possibility of some supernumerary glands, it is desirable to have an imagistic map as accurate as possible, thus avoiding the risk of postoperative recurrence. The available imaging investigations are represented by the ultrasound of the cervical region, the parathyroid scintigraphy and those of the second line - CT or MRI examination. If in primary hyperparathyroidism, where there is only one parathyroid adenoma (or two), the preoperative imaging results are satisfactory, in sHPT there are many cases in which the imaging does not reveal all four parathyroid glands.


Assuntos
Hiperparatireoidismo Secundário/cirurgia , Glândulas Paratireoides/diagnóstico por imagem , Insuficiência Renal Crônica/complicações , Calcinose/etiologia , Doenças Cardiovasculares/etiologia , Humanos , Hiperparatireoidismo Secundário/etiologia , Glândulas Paratireoides/cirurgia , Paratireoidectomia , Calcificação Vascular/etiologia
6.
BMC Surg ; 19(1): 133, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31510980

RESUMO

BACKGROUND: Tumoral calcinosis (TC) is a rare disease derived from uremic secondary hyperparathyroidism (SHPT). However, parathyroidectomy (PTX) seems to be ineffective at relieving TC in some patients. In this study, we investigated the relationship between PTX and TC shrinkage. METHODS: We retrospectively followed up nine TC patients who underwent PTX, dividing them into two groups: those with TC size reduced by > 80% were in the "effective group" (group A), and the rest in the "ineffective group" (group B). RESULTS: We enrolled nine patients (7 men; mean age 38.6 ± 10.9 years) with SHPT-related TC. One patient with calciphylaxis was excluded due to sudden death. The efficiency of PTX in causing TC regression was 62.5% (5 patients in group A). Group A had a shorter overall duration of TC (6 [5.5, 6.0] vs. 9 [8.0, 10.0] months; P = 0.02) and higher serum levels of alkaline phosphatase (ALP; 408.0 [217.9, 1101.7] vs. 90.8 [71.0, 102.1] pg/ml; P = 0.03) and high-sensitivity C-reactive protein (hs-CRP; 82.7 [55.0, 112.4] vs. 3.1 [3.1, 4.5] mg/l; P = 0.02). Average calcium supplementation within 1 week of surgery was significantly greater in group A than in group B (96.8 [64.1, 105.3] vs. 20.1 [13.1, 32.7] g; P = 0.04). Patients in both the groups demonstrated similar serum phosphate levels before PTX, but these levels were higher in group B than in group A at follow-up times (3 months, P = 0.03; 6 months, P = 0.03). CONCLUSIONS: The shorter duration of pre-existing TC and higher ALP levels before PTX, as well as lower serum phosphate levels after PTX, were correlated with effective SHPT-TC shrinkage.


Assuntos
Calcinose/etiologia , Hiperparatireoidismo Secundário/cirurgia , Paratireoidectomia/métodos , Adulto , Proteína C-Reativa/metabolismo , Calcinose/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
J Radiol Case Rep ; 13(8): 1-18, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31558966

RESUMO

Intracranial calcifications are frequently encountered in non-contrast computed tomography scan in both adult and pediatric age groups. They refer to calcifications within the brain parenchyma or vasculature and can be classified into several major categories: physiologic/age-related, dystrophic, congenital disorders/phakomatoses, infectious, vascular, neoplastic, metabolic/endocrine, inflammatory and toxic diseases. In this updated review, we present a wide spectrum of intracranial calcifications from both pediatric and adult populations focusing on their pattern, size and location.


Assuntos
Encefalopatias/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Calcificação Fisiológica , Calcinose/diagnóstico por imagem , Encefalopatias/etiologia , Calcinose/etiologia , Humanos , Terminologia como Assunto , Tomografia Computadorizada por Raios X
8.
Rev Inst Med Trop Sao Paulo ; 61: e39, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31411269

RESUMO

Acute petrified myocardium associated with septic shock, diagnosed by autopsy has rarely been described. A 15-year-old adolescent male was diagnosed with childhood-onset systemic lupus erythematosus. One year later, he was hospitalized with fever, myalgia, headache, arthritis, vomiting, dyspnea and was diagnosed with sepsis secondary to bronchopneumonia and meningitis. Blood culture identified Neisseria meningitidis serogroup Y. Despite antibiotics and intensive therapeutic measures, he died after 29 days of hospitalization. The autopsy revealed necrotic cardiomyocytes with dystrophic calcification and interstitial fibrosis.


Assuntos
Calcinose/etiologia , Cardiomiopatias/etiologia , Lúpus Eritematoso Sistêmico/complicações , Infecções Meningocócicas/complicações , Sepse/complicações , Adolescente , Calcinose/diagnóstico por imagem , Calcinose/patologia , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/patologia , Evolução Fatal , Humanos , Masculino
10.
BMC Musculoskelet Disord ; 20(1): 362, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391033

RESUMO

BACKGROUND: Fahr's syndrome presenting multiple and symmetric calcification of basal ganglia and cerebral cortex is rare, and idiopathic hypoparatyroidism is known as one of the causes. The relationship between ossification of posterior longitudinal ligament (OPLL) and idiopathic hypoparatyroidism is also reported in a few cases. Here, we report a patient presenting concomitant Fahr's syndrome and thoracic OPLL developed by idiopathic hypoparatyroidism. CASE PRESENTATION: 53-year-old female patient presented myelopathic sign including gait disturbance and both leg weakness (Grade 3) for 4 months after slip down, and has the history of anti-epileptic medication for several years. Magnetic resonance imaging revealed cord compression by the mixed-type OPLL from T5 to T9, and decompressive surgery was planned. Sudden onset generalized tonic-clonic seizure attack developed before the surgery. Hypocalcemia (3.7 mg/dL) with QT prolongation on electrocardiogram, hypomagnesemia (1.4 mg/dL), hyperphosphatemia (7.7 mg/dL), hypoparathyroidism, and normal range of vitamin D was noted. Brain study showed Fahr's syndrome with multiple and symmetric calcification of basal ganglia, cerebral cortex, and cerebellum. Decompressive laminectomy was performed after transient correction of hypocalcemia. The myelopathic symptoms improved to normal walking by the 14-month follow-up. The cause of hypoparathyroidism was concluded to be idiopathic. CONCLUSION: Concomitant expression of Fahr's syndrome and OPLL related with idiopathic hypoparatyroidism is very rare. However, we recommend considering the possibility of hypoparathyroidism and Fahr's syndrome when we evaluate the patients with OPLL to avoid the risks of sudden onset seizure and cardiac arrhythmia due to cerebral lesions and hypocalcemia.


Assuntos
Doenças dos Gânglios da Base/etiologia , Calcinose/etiologia , Hipoparatireoidismo/complicações , Doenças Neurodegenerativas/etiologia , Ossificação do Ligamento Longitudinal Posterior/etiologia , Doenças dos Gânglios da Base/diagnóstico , Encéfalo/diagnóstico por imagem , Calcinose/diagnóstico , Descompressão Cirúrgica , Feminino , Humanos , Hipoparatireoidismo/diagnóstico , Ligamentos Longitudinais/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Doenças Neurodegenerativas/diagnóstico , Ossificação do Ligamento Longitudinal Posterior/diagnóstico , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Vértebras Torácicas , Tomografia Computadorizada por Raios X
11.
Rinsho Ketsueki ; 60(7): 785-790, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31391367

RESUMO

Ectopic soft tissue calcification (ESTC), a rare clinical condition, causes tissue and organ damage. It is associated with chronic renal failure, hyperparathyroidism, and malignant neoplasms, including multiple myeloma, and it is reportedly resistant to treatment. Here, we present the case of a 71-year-old male with multiple myeloma who had rapid ESTC in the lung. He had developed hypoparathyroidism secondary to thyroidectomy. During the course of our observation, he rapidly developed ectopic pulmonary calcification approximately 2 weeks after acquiring an infection. There was no evidence of further progression of multiple myeloma after the onset of ESTC, and treatment with ferric citrate hydrate and precipitated calcium resulted in immediate improvement of his pulmonary signs. We recommend cautious monitoring for patients with multiple myeloma and hypoparathyroidism to detect the onset of ectopic calcification. In addition, low blood phosphorus levels should be effectively treated.


Assuntos
Calcinose/etiologia , Mieloma Múltiplo/complicações , Paratireoidectomia/efeitos adversos , Idoso , Humanos , Masculino
12.
Mymensingh Med J ; 28(3): 600-604, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31391433

RESUMO

Calcification of soft tissue and blood vessel wall occurs more frequently in dialyzed patients. The purpose of the present study was to estimate the risk of abdominal aortic calcification among end stage renal disease patients under maintenance haemodialysis. This case-control study was carried out in the Department of Nephrology at National Institute of Kidney Diseases and Urology (NIKDU), Dhaka and National Institute of Cardiovascular Disease and Hospital (NICVD), Dhaka, Bangladesh from January 2013 to December 2014 for a period of two (02) years. Chronic kidney disease in stage 5 {CKD-5(D)} patients older than 18 years on maintenance haemodialysis (MHD) for more than 3 months were selected as case group. And same age and sex non CKD patients were considered as control group. Serum calcium, serum albumin, serum phosphate and iPTH were estimated by semi-automated biochemistry analyzer from the Department of Biochemistry of NIKDU, Dhaka and NICVD, Dhaka. Plain X-ray abdomen in lateral view was performed for all patients. Total 100 patients were enrolled for this study of which 50 patients were in end stage renal disease (ESRD) group and the rest 50 patients were in non-CKD group. Abdominal aortic calcification on X ray was present in 22(44%) patients of ESRD group and 6(12%) patients of non CKD group of population. Mean±SD serum calcium (corrected) level was significantly high (p<0.001) in ESRD patients (9.79±0.87) compared to non CKD group of population (9.13±0.70). Mean±SD of serum phosphate level was significantly higher (p<0.001) in ESRD patients (5.71±0.96) compared to non CKD group of population (4.20±0.59). However, mean±SD iPTH level showed no significant difference between ESRD (25.33±51.98) and non CKD group of population (38.53±19.52), though iPTH level remain below the target level in ESRD group. Abdominal aortic calcification is significantly higher among ESRD subjects.


Assuntos
Aorta Abdominal , Calcinose , Falência Renal Crônica , Insuficiência Renal Crônica , Aorta Abdominal/patologia , Bangladesh , Calcinose/etiologia , Estudos de Casos e Controles , Humanos , Diálise Renal , Insuficiência Renal Crônica/complicações , Fatores de Risco
13.
J Diabetes Res ; 2019: 9484717, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31192264

RESUMO

Objectives: Type 2 diabetes mellitus (T2DM) is associated with coronary artery calcification (CAC) which is an independent risk factor for cardiovascular events. Metformin is the first-line antidiabetic medication. We aimed to investigate the association between metformin use and CAC. Methods: We included 369 patients with T2DM in this cross-sectional study. CAC scores, clinical characteristics, and antidiabetic drug prescription information of the patients were acquired. Baseline parameters were balanced for metformin and nonmetformin users using the propensity score matching (PSM) strategy. Results: Among the 369 subjects who met our inclusion criteria, 288 subjects were included for further analysis after PSM. Metformin prescription rather than other antidiabetic medications was related to lower CAC scores (OR [95% CI] = 0.55 [0.34-0.90]; P = 0.018). Further multivariable logistic regression analysis demonstrated that metformin was negatively associated with CAC severity (OR [95% CI] = 0.58 [0.34-0.99]; P = 0.048), which was independent of age, BMI, eGFR, gender, cigarette smoking, duration of diabetes, hypertension, statin prescription, and number of nonmetformin antidiabetic agents. A subgroup analysis revealed a significant association between metformin and CAC scores in smokers (OR [95% CI] = 0.38 [0.16-0.93]; P = 0.035), but the association was not observed in never-smokers (OR [95% CI] = 0.72 [0.34-1.51]; P = 0.383). Conclusions: Metformin usage was independently associated with lower CAC scores in T2DM patients. The negative correlation between CAC scores and metformin was most prominent in patients with a history of cigarette smoking.


Assuntos
Calcinose/etiologia , Doença da Artéria Coronariana/etiologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/efeitos adversos , Metformina/efeitos adversos , Idoso , Calcinose/complicações , Doença da Artéria Coronariana/complicações , Vasos Coronários/efeitos dos fármacos , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Feminino , Taxa de Filtração Glomerular , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estresse Oxidativo , Pontuação de Propensão , Fatores de Risco , Fumar , Tomografia Computadorizada por Raios X
14.
Acta Med Port ; 32(5): 402-406, 2019 May 31.
Artigo em Português | MEDLINE | ID: mdl-31166902

RESUMO

Pathological basal ganglia calcification, or Fahr's Syndrome, can be secondary to a variety of diseases, namely parathyroid disturbances. Movement disorders are common clinical features, in which chorea is seen in less than 20% of cases and dystonia just in 8%. We report the clinical case of a 49-year-old male with a history of thyroidectomy, who was admitted in Emergency Service with acute generalized chorea and focal painful feet dystonia. Laboratory analysis showed hypocalcemia and rhabdomyolysis, and computed tomography scan revealed parenchymal calcification with basal ganglia involvement. After complementary studies we established a Fahr's Syndrome diagnosis secondary to an iatrogenic hypoparathyroidism. Clinical management has been successful with stabilized calcium levels, with no more neurologic symptoms. Hypocalcemia should be readily investigated and treated after a thyroidectomy, given the irreversibility of intracerebral calcifications and potential neurological or systemic consequences.


Assuntos
Doenças dos Gânglios da Base/etiologia , Calcinose/etiologia , Coreia/etiologia , Distonia/etiologia , Hipoparatireoidismo/complicações , Doenças Neurodegenerativas/etiologia , Doenças dos Gânglios da Base/diagnóstico , Calcinose/diagnóstico , Humanos , Hipocalcemia/diagnóstico , Hipocalcemia/etiologia , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , Doenças Neurodegenerativas/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Tireoidectomia/efeitos adversos , Tomografia Computadorizada por Raios X
15.
BMJ Case Rep ; 12(6)2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31167769

RESUMO

Petrified pinna refers to the calcification or ossification of the external auricular cartilage. It is an uncommon clinical entity and is most often associated with local trauma, frostbite or inflammation. Auricular calcification may be the exclusive cutaneous marker of underlying endocrinopathy. It has been most commonly associated with adrenal insufficiency and other endocrine conditions like diabetes mellitus, hypothyroidism and acromegaly. We present a 47-year-old Caucasian manwho presented with acute pericarditis with tamponade physiology, who was found to have petrified pinnae as a telltale sign of the underlying autoimmune polyendocrine syndrome type 2.


Assuntos
Calcinose/etiologia , Pavilhão Auricular/patologia , Pericardite/etiologia , Poliendocrinopatias Autoimunes/diagnóstico , Insuficiência Adrenal/tratamento farmacológico , Diagnóstico Diferencial , Síndrome da Sela Vazia/diagnóstico por imagem , Humanos , Hipotireoidismo/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Pericardiocentese/métodos , Pericardite/diagnóstico por imagem , Pericardite/terapia , Poliendocrinopatias Autoimunes/complicações , Poliendocrinopatias Autoimunes/imunologia , Resultado do Tratamento
18.
J Pak Med Assoc ; 69(4): 600, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31000873

RESUMO

Metastatic calcification relates to abnormal calcification resulting from hypercalcaemia in otherwise normal tissues. Hypercalcaemia can occur secondary to chronic renal failure, hyperparathyroidism, hypervitaminosis D, and metastatic neoplasms. Specific symptoms are often lacking, but calcification may be a marker of disease severity and its chronicity. We present cases with different patterns of soft tissue calcification on Tc99m MDP bone scan.


Assuntos
Calcinose/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Idoso , Neoplasias Ósseas/complicações , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Neoplasias da Mama/patologia , Calcinose/etiologia , Carcinoma/complicações , Carcinoma/diagnóstico por imagem , Carcinoma/secundário , Feminino , Humanos , Hipercalcemia/complicações , Falência Renal Crônica , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Cintilografia , Compostos Radiofarmacêuticos , Medronato de Tecnécio Tc 99m
19.
J Card Surg ; 34(6): 511-513, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31017327

RESUMO

A 75-year-old woman presented at a prior hospital with persistent cough and was treated conservatively for a thrombosed-type aortic dissection (Stanford A). One-year after discharge, follow-up computerized tomography revealed a DeBakey type II, chronic dissecting aortic aneurysm enlarged to 54 mm. She was referred to our hospital with slight edema in the face and extremities and chest radiography showed calcification around the heart. Computerized tomography performed at the prior hospital showed a large spherical mass in the anterior pericardium in addition to the aortic dissection. We therefore resected the mass immediately before a total aortic arch replacement. Surgery was successful and uneventful with patient discharge on postoperative day 21. The final differential diagnosis was idiopathic, localized, constrictive pericarditis.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/métodos , Calcinose/cirurgia , Cardiomiopatias/cirurgia , Pericardite Constritiva/complicações , Pericardite Constritiva/cirurgia , Pericárdio/cirurgia , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Calcinose/patologia , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/etiologia , Cardiomiopatias/patologia , Doença Crônica , Feminino , Humanos , Pericardite Constritiva/patologia , Pericárdio/diagnóstico por imagem , Pericárdio/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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